normal common femoral artery velocity

In obstructive disease, waveform is monophasic and dampened. Collectively, they comprise a powerful toolset for defining the functionality of . Scan plane for the femoral artery as it passes through the adductor canal. A weak dorsalis pedis artery pulse may be a sign of an underlying circulatory condition, like peripheral artery disease (PAD). In addition, catheter contrast arteriography provides anatomic rather than physiologic information and may be subject to variability at the time of interpretation. Every major vessel in the human body has a characteristic flow pattern that is visible in spectral waveforms obtained in that vessel with Doppler ultrasonography (US). Serial finger pressures measured while perfusing cold fluid until pressure is reduced by 17% compared to a reference finger without cold perfusion. Recordings should also be made at the following standard locations: (1) the proximal and distal abdominal aorta; (2) the common, internal, and external iliac arteries; (3) the common femoral and proximal deep femoral arteries; (4) the proximal, middle, and distal superficial femoral artery; (5) the popliteal artery; and (6) the tibial/peroneal arteries at their origins and at the level of the ankle. Focused examination of abnormal segments is more efficient when single lesions are identified with the indirect tests. Peak systolic velocity is low at approximately 41cm/s, and there is no flow in diastole. These are some common normal peak systolic velocities: Peripheral artery stenosis is considered significant when the diameter reduction is 50% or greater, which corresponds to 75% cross sectional area reduction. Experimental work has shown that the high-velocity jets and turbulence associated with arterial stenoses are damped out over a distance of only a few vessel diameters. The purpose of noninvasive testing for lower extremity arterial disease is to provide objective information that can be combined with the clinical history and physical examination to serve as the basis for decisions regarding further evaluation and treatment. For a complete lower extremity arterial evaluation, scanning begins with the upper portion of the abdominal aorta. A portion of the common iliac vein is visualized deep to the common iliac artery. There is no significant difference in velocity measurements among the three tibial/peroneal arteries in normal subjects. Several large branches can often be seen originating from the distal superficial femoral artery and popliteal artery. FIGURE 17-7 Spectral waveforms obtained from a normal proximal superficial femoral artery. Cardiology Today Intervention | The preferred revascularization strategy for symptomatic common femoral artery stenosis is unknown. Arterial lesions disrupt this normal laminar flow pattern and give rise to characteristic changes that include increases in PSV and a widening of the frequency band that is referred to as spectral broadening. TABLE 17-1 Mean Arterial Diameters and Peak Systolic Flow Velocities*. A variety of transducers are often needed for a complete lower extremity arterial duplex examination. Arteriographic severity of aortoiliac occlusive disease was subdivided into three groups: group 1, normal or hemodynamically insignificant (<50%) stenosis; group 2, hemodynamically significant (50%) stenosis; and group 3, total aortoiliac occlusion. These imaging modalities are also valuable for recognizing anatomic variations and for identifying arterial disease by showing plaque or calcification. These presets can be helpful, especially during the learning process, but these parameters may not be adequate for all patient examinations. The venous pressure within the common femoral vein is higher than normal if a continuous Doppler signal is obtained. An electric blanket placed over the patient prevents vasoconstriction caused by low room temperatures. It is now possible to predict the normal CFA diameter, and nomograms that may be used in the study of aneurysmal disease are presented. The waveforms show a triphasic velocity pattern and contain a narrow band of frequencies with a clear area under the systolic peak. PMC Gmez-Garca M, Torrado J, Bia D, Zcalo Y. Spectral waveforms obtained just proximal to the origin of the celiac artery show a normal aortic flow pattern. Any stenosis or occlusion lengths, including measurements from the groin crease, patella or malleolus. The flow pattern in the center stream of normal lower extremity arteries is relatively uniform, with the red blood cells all having nearly the same velocity. A Vr of 2.0 or greater is a reasonable compromise and is used by many vascular laboratories as a threshold for a peripheral artery stenosis of 50% or greater diameter reduction. Color flow image of a normal aortic bifurcation obtained from an oblique approach at the level of the umbilicus. A stenosis of greater than 70% was diagnosed either if the peak systolic velocity was more than 160 cm/sec (sensitivity 77%, specificity 90%) of if there was an increase in peak systolic velocity of 100% with respect to the arterial segment above the stenosis (sensitivity 80%, specificity 93%). government site. Minimal disease (1% to 19% diameter reduction) is indicated by a slight increase in spectral width (spectral broadening), without a significant increase in PSV (<30% increase in PSV compared with the adjacent proximal segment). A color flow image displays flow abnormalities as focal areas of aliasing or color bruit artifacts that enable the examiner to place the pulsed Doppler sample volume in the region of flow disturbance and obtain spectral waveforms. The color flow image shows the common femoral artery bifurcation and the location of the pulsed Doppler sample volume. The color change in the common iliac segment is related to different flow directions with respect to the transducer. A left lateral decubitus position may also be advantageous for the abdominal portion of the examination. Identification of these vessels is facilitated by visualization of the adjacent paired veins (see Figure 17-2). To date, there have been many criteria proposed for grading the degree of arterial narrowing from the duplex scan. 80 70 60 50- 40- 30- 20- 10 Baseline FIG. If specifically indicated, the mesenteric and renal vessels can be examined at this time, although these do not need to be examined routinely when evaluating the lower extremity arteries. No flow is seen in the left CIV, whereas normal flow is observed in the right CIV (B). Heavily calcified vessels and large patient habitus reduce detail and may limit ability to obtain a good doppler trace accurately angle corrected. When examining an arterial segment, it is essential that the ultrasound probe be sequentially moved along the artery at closely spaced intervals in order to evaluate blood flow patterns in an overlapping fashion. These are typical waveforms for each of the stenosis categories described in Table 17-2. SCAN PROTOCOL Role of Ultrasound To date, there have been many criteria proposed for grading the degree of arterial narrowing from the duplex scan. Hemodynamically significant stenoses in lower extremity arteries correlate with threshold Vr values ranging from 1.4 to 3.0. The spectral window is the area under the trace. The velocity increases from 150 to 300 m/s across the stenosis Colour duplex scanning of blood flow through stenosis of superficial femoral artery. 15.5 ). C. Pressure . 1 ). Therefore, the flow is laminar, and the corresponding spectral waveform contains a narrow band of frequencies with a clear area under the systolic peak (Figures 17-7 and. FIGURE 17-1 Duplex scan of a severe superficial femoral artery stenosis. Before A A. However, some examiners prefer to image the popliteal segment with the patient supine and the leg externally rotated and flexed at the knee. This may be uncomfortable on the patient. It is usually convenient to examine patients early in the morning after an overnight fast. 15.6 ). Normal PSV in lower-limb arteries is in the range of 55 cm/s at the tibial artery to 110 cm/s at the common femoral artery (Table 2 ). A velocity ratio > 4 suggests greater than 80% stenosis. FIGURE 17-5 Color flow image of a normal right common iliac artery bifurcation obtained at the level of the iliac crest. Therefore the flow is laminar, and the corresponding spectral waveform contains a narrow band of frequencies with a clear area under the systolic peak ( Figs. Increased signal amplitude affecting slow flow velocities. Pressures from 80-30 mmHg indicate mild to moderate disease and those <30 mmHg indicate critical disease. For ultrasound examination of the aorta and iliac arteries, patients should fast for about 12 hours to reduce interference by bowel gas. Change to linear probe (5-7MHz), patient still supine. Catheter contrast arteriography has generally been regarded as the definitive examination for lower extremity arterial disease, but this approach is invasive, expensive, and poorly suited for screening or long-term follow-up testing. The common femoral is a peripheral artery and should have high resistant flow in normal patients. An important difference between spectral waveform analysis and color flow imaging is that spectral waveforms display the entire frequency and amplitude content of the pulsed Doppler signal at a specific site, whereas the color flow image provides a single estimate of the Doppler shift frequency or flow velocity for each site within the B-mode image. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome, and cystic adventitial disease. Function. The maximum and mean values of WSS, and the Tur values at early-systole, mid-systole, late-systole, and early diastole for total 156 normal peripheral arteries [common carotid arteries (CCA), subclavian arteries (SCA), and common femoral arteries (CFA)] were assessed using the V Flow technique.ResultsThe mean WSS values for CCA, SCA, and CFA . Methods: reported that 50 Hz increased the skin blood flow more than 30 Hz while uniquely resting the arm on a vertical vibration . Because flow velocities distal to an occluded segment may be low, it is important to adjust the Doppler imaging parameters of the instrument to detect low flow rates. In a normal vessel the velocity of blood flow and the pressure do not change significantly. Lengths of occluded arterial segments can be measured with a combination of B-mode, color flow, and power Doppler imaging by visualizing the point of occlusion proximally and the distal site where flow reconstitutes through collateral vessels. The purpose of noninvasive testing for lower extremity arterial disease is to provide objective information that can be combined with the clinical history and physical examination to serve as the basis for decisions regarding further evaluation and treatment. Noninvasive physiologic vascular studies play an important role in the diagnosis and characterization in peripheral arterial disease (PAD) of the lower extremity. There is evidence that the application of these less-invasive approaches to arterial imaging has decreased the utilization of diagnostic catheter contrast arteriography. Spectral waveforms obtained from the site of stenosis indicate peak velocities over 500 cm/sec. Noninvasive testing for lower extremity arterial disease provides objective information that can be combined with the clinical history and physical examination to serve as the basis for decisions regarding further evaluation and treatment. These are readily visualized with color flow or power Doppler imaging and represent the geniculate and sural arteries. Abstract This retrospective study determined the duplex ultrasound scanning criteria for detecting 50%-69% and 70%-99% stenosis of the superficial femoral artery (SFA). Andrew Chapman. Young Jin . Careers. Clipboard, Search History, and several other advanced features are temporarily unavailable. The vein velocity ratio is 5.8. The hepatic and splenic Doppler waveforms also have this low-resistance pattern. Attention then turns back to the superficial femoral artery, which is followed down to the level of the knee. After the common femoral and the proximal deep femoral arteries are studied, the superficial femoral artery is followed as it courses down the thigh. (A) Color flow image and pulsed Doppler waveforms taken from the left common femoral artery (. These studies are usually guided by the indirect studies that identify a region of abnormality. The reverse flow component is also absent distal to severe occlusive lesions. There was no significant difference in PSV in the three tibial/peroneal arteries in the healthy subjects. Satisfactory aortoiliac Doppler signals can be obtained from approximately 90% of individuals that are prepared in this way. For a complete lower extremity arterial evaluation, scanning begins with the upper portion of the abdominal aorta. The reverse flow component is a consequence of the relatively high peripheral vascular resistance in the normal lower extremity arterial circulation. The spectral display depicts a sharp upstroke or acceleration in an arterial waveform velocity profile from a normal vessel. After it enters the thigh under the inguinal ligament, it changes name and continues as the common femoral artery, supplying the lower limb. FIGURE 17-8 Lower extremity artery spectral waveforms. Lengths of occluded arterial segments can be measured with a combination of B-mode, color flow, and power Doppler imaging by visualizing the point of occlusion proximally and the distal site where flow reconstitutes through collateral vessels. 6 (3): 213-21. The superficial femoral artery (SFA), as the longest artery with the fewest side branches, is subjected to external mechanical stresses, including flexion, compression, and torsion, which significantly affect clinical outcomes and the patency results of this region after endovascular revascularization. Physiologic State of Normal Peripheral Arterial Waveforms. Presence of triphasic flow does not exclude proximal stenosis in a symptomatic patient. Peri-aortic soft tissues are within normal limits." Comment: Both color Doppler and spectral Doppler are noted in addition to a statement on the flow pattern. This is seen as filling-in of the normal clear area under the systolic peak (see Fig. For a complete lower extremity arterial evaluation, scanning begins with the proximal segment of the abdominal aorta. Meanwhile, Maloney-Hinds et al. This may require applying considerable pressure with the transducer to displace overlying bowel loops. Peak systolic velocities are approximately 80 cm/sec. The reverse flow component is also absent distal to severe occlusive lesions. Hirschman was correct in saying that it was unusual to find clot in the leg artery, and the material that he did find and extract appears to have been extremely abnormal. Pressure gradients are set up. Color flow image of a normal right common iliac artery bifurcation obtained at the level of the iliac crest. Common femoral endarterectomy has been the preferred treatment . Because local flow disturbances are usually apparent with color flow imaging (see Fig. The range of normal blood flow velocity in the celiac artery is 98 to 105 cm/s. . The diameter of the CFA was measured in 122 healthy volunteers (59 male, 63 female; 8 to 81 years of age) with echo-tracking B-mode ultrasound scan. You will need firm gradually applied pressure to displace bowel gas. Significant correlations were found between the CFA diameter and weight (r = 0.58 and r = 0.57 in male and female subjects, respectively; P <.0001), height (r = 0.49 and r = 0.54 in male and female subjects, respectively; P <.0001), and BSA (r = 0.60 and r = 0.62 in male and female subjects, respectively; P <.0001). 5 Q . Color flow image shows a localized, high-velocity jet. Duplex scan of a severe superficial femoral artery stenosis. FIGURE 17-7 Spectral waveforms obtained from a normal proximal superficial femoral artery. This chapter reviews the current status of duplex scanning for the initial evaluation of lower extremity arterial disease. Loss of triphasic waveforms, presence of spectral broadening, and post stenotic turbulence are signs of significant stenosis. But it's usually between 7 and 8 millimeters across (about a quarter of an inch). Color flow image of the posterior tibial and peroneal arteries and veins. C. The internal iliac artery becomes the common femoral artery. These vessels are best evaluated by identifying their origins from the distal popliteal artery and scanning distally or by finding the arteries at the ankle and working proximally. The origins of the celiac and superior mesenteric arteries are well visualized. Locate the iliac arteries. Age and BSA were used to create a model for prediction of the CFA diameter (r = 0.71 and r = 0.77 in male and female subjects, respectively; P <.0001). The diameter of the artery varies widely by sex, weight, height and ethnicity. In general, the highest-frequency transducer that provides adequate depth penetration should be used. The femoral artery, vein, and nerve all exist in the anterior region of the thigh known as the femoral triangle, just inferior to . Linear relationships between the reciprocal of PI and volume flow were found and expressed as linear blood flow equations. 3. Longitudinal B-mode image of the proximal abdominal aorta. The tibial and peroneal arteries distal to the tibioperoneal trunk can be difficult to examine completely, but they can usually be imaged with color flow or power Doppler. Although women had smaller arteries than men, peak systolic flow velocities did not differ significantly between men and women in this study. Would you like email updates of new search results? PSV = peak systolic velocity. Identification of these vessels is facilitated by visualization of the adjacent paired veins (see Fig. The common femoral artery is a continuation of the external iliac artery. Monophasic flow: Will be present approach an occlusion (or near occlusion). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Bookshelf Bidirectional flow signals. This is necessary because the flow disturbances produced by arterial lesions are propagated along the vessel for a relatively short distance. A PI of >5.5 is normal for the common femoral artery, while a normal PI for the popliteal artery is approximately 8.0. Colour assignment (red or blue) depends on direction of CFA, common femoral artery; CW, continuous wave; PRA, profunda artery; PRF . Effect of Bariatric Surgery on Intima Media Thickness: A Systematic Review and Meta-Analysis. Color flow image of a normal right common iliac artery bifurcation obtained at the level of the iliac crest. Each lower extremity is examined in turn, beginning with the common femoral artery and working distally. If a patient has an angioma, the characteristic changes that would be seen in the vessels supplying the angioma would include: Clearly reduced pulsatility indices. Common femoral artery 114 cm/s Superficial femoral artery 91 cm/s Popliteal artery 69 cm/s Peripheral artery stenosis is considered significant when the diameter reduction is 50% or greater, which corresponds to 75% cross sectional area reduction. These spectral waveforms contain a range of frequencies and amplitudes that allow determination of flow direction and parameters such as mean and peak velocity. The posterior tibial vessels are located more superficially (toward the top of the image). advanced. Measurements by duplex scanning in 55 healthy subjects. A. Catheter contrast arteriography has historically been the definitive examination for lower extremity arterial disease, but this approach is invasive, expensive, and poorly suited for screening or long-term follow-up testing. Front Sports Act Living. If possible, roll the patient onto their ipsilateral side with the contralateral leg forward over the top. Sandgren T, Sonesson B, Ahlgren AR, Lnne T. J Vasc Surg. Low-frequency (2 MHz or 3 MHz) transducers are best for evaluating the aorta and iliac arteries, whereas a higher-frequency (5 MHz or 7.5 MHz) transducer is adequate in most patients for the infrainguinal vessels. The color flow image helps to identify vessels and the flow abnormalities caused by arterial lesions (Figures 17-1 and. 8. As with other applications of arterial duplex scanning, Doppler angle adjustment is required for accurate velocity measurements. However, it should be emphasized that color flow Doppler and power Doppler imaging are not replacements for spectral waveform analysis, the primary method for classifying the severity of arterial disease.10. For the evaluation of the abdominal aorta and lower extremity arteries, pulsed Doppler measurements should include the following standard locations: (1) the proximal, middle, and distal abdominal aorta; (2) the common iliac, proximal internal iliac, and external iliac arteries; (3) the common femoral and proximal deep femoral arteries; (4) the proximal, middle, and distal superficial femoral artery; (5) the popliteal artery; and (6) the tibial/peroneal arteries at their origins and at the level of the ankle. R-CIA, right common iliac artery; L-CIA, left common iliac artery. 15.2 ). The more specialized application of follow-up after arterial interventions is covered in Chapter 16 . Citation, DOI & article data. These are readily visualized with color flow or power Doppler imaging and represent the geniculate and sural arteries (see Chapter 11 ). Rarely used and not specific to disease, with 50% false positive rate. Criteria which have been devised for the carotid duplex scancannotbe used for the peripheral arteries. Moderate stenosis (20% to 49% diameter reduction) is characterized by more prominent spectral broadening and by an increase in PSV up to 100% compared with the adjacent proximal segment. 17 Ultrasound Assessment of Lower Extremity Arteries. Lower extremity arterial duplex examination of a 49-year-old diabetic patient with left leg pain. 2001 Dec;34(6):1079-84. doi: 10.1067/mva.2001.119399. A portion of the common iliac vein is visualized deep to the common iliac artery. The color flow image helps to identify vessels and the flow abnormalities caused by arterial lesions (Figures 17-1 and 17-2). Bethesda, MD 20894, Web Policies The aorta is followed distally to its bifurcation, which is visualized by placing the transducer at the level of the umbilicus and using an oblique approach (Figure 17-4). The posterior tibial and peroneal arteries arise from the tibioperoneal trunk and can be difficult to examine completely, but they can usually be seen by using color flow or power Doppler imaging. Nielsens test involves using a finger cuff perfused by cold fluid. Color flow image and pulsed Doppler spectral waveforms obtained from a site just proximal to a severe superficial femoral artery stenosis. Jager and colleagues determined standard values for arterial diameter and peak systolic blood flow velocity in the lower extremity arteries of 55 healthy subjects (30 men, 25 women) ranging in age from 20 to 80 years ( Table 15.1 ). 15.9 ). This vein collects deoxygenated blood from tissues in your lower leg and helps move it to your heart. Example of a vascular laboratory worksheet used for lower extremity arterial assessment. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Ultrasound Assessment of Lower Extremity Arteries, Ultrasound Assessment of Lower Extremity Arteries, Ultrasound Contrast Agents in Vascular Disease, Ultrasound in the Assessment and Management of Arterial Emergencies, Ultrasound Assessment During and after carotid, Triphasic waveform with minimal spectral broadening, Triphasic waveform usually maintained (although reverse flow component may be diminished), Monophasic waveform with loss of the reverse flow component and forward flow throughout the cardiac cycle, No flow is detected within the imaged arterial segment. Blood velocity distribution in the femoral artery. The stenosis PSV to pre-stenotic PSV is 2.0 or greater. The single arteries and paired veins are identified by their flow direction (color). See Table 23.1. Duplex instruments are equipped with presets or combinations of ultrasound parameters for gray-scale and Doppler imaging that can be selected by the examiner for a particular application. a Measurements by duplex scanning in 55 healthy subjects. Means are indicated by transverse bars. FIG.2. 2022 Feb 24;4:799659. doi: 10.3389/fspor.2022.799659. Pulsed Doppler recordings should be taken at the following standard locations: (1) the proximal, middle, and distal abdominal aorta; (2) the common iliac, proximal internal iliac, and external iliac arteries; (3) the common femoral and proximal deep femoral arteries; (4) the proximal, middle, and distal superficial femoral artery; (5) the popliteal artery; and (6) the tibial/peroneal arteries at their origins and at the level of the ankle. The patient is initially positioned supine with the hips rotated externally. abdominal aorta: <3 cm diameter. Aorta. Take peak systolic measurements using spectral doppler at the Common femoral artery and Profunda femoris artery. appendix: on CT <6 mm caliber. Examine in B mode and colour doppler with peak systolic velocities taken at the LCIA origin, LIIA origin and the mid distal LEIA. . For lower extremity duplex scanning, pulsed Doppler spectral waveforms should be obtained at closely spaced intervals because the flow disturbances produced by arterial lesions are propagated along the vessel for a relatively short distance (about 1 or 2 vessel diameters). Locate the posterior tibial and peroneal arteries by placing the toe of the probe on the distal tibia and scanning transverse. A complete understanding of the ultrasound parameters that are under the examiners control (i.e., color gain, color Doppler velocity scale, pulse repetition frequency or scale for Doppler spectral waveforms, wall filter) is essential for optimizing arterial duplex scans. FAPs. Running as a continuation of the anterior tibial artery, the blood vessel carries oxygenated blood to the dorsal surface (upper side) of the foot. This artery begins near your groin, in your upper thigh, and follows down your leg . Pulsed Doppler spectral waveforms are recorded from any areas in which increased velocities or other flow disturbances are noted. The common femoral artery is the portion of the femoral artery between the inguinal ligament and branching of profunda femoris, and the superficial femoral artery is the portion distal to the branching of profunda femoris to the adductor hiatus. This flow pattern is also apparent on color flow imaging. In spastic syndrome, the waveform has a rounded peak and early shift of the dicrotic notch. 15.7 . Although women had smaller arteries than men, peak systolic flow velocities did not differ significantly between men and women in this study. Compression test. The common femoral artery begins four centimeters proximal, or cephalad, to the inguinal ligament. In longitudinal, use colour doppler to confirm patency whilst checking for aliasing which may indicate stenoses. These are typical waveforms for each of the stenosis categories described in Table 17-2. In the absence of disease, the diastolic component in an arterial waveform reflects the vasoconstriction present in the resting muscular beds. 1998 Aug;28(2):284-9. doi: 10.1016/s0741-5214(98)70164-8. For ultrasound examination of the aorta and iliac arteries, patients should be fasting for about 12 hours to reduce interference by bowel gas. In general, the highest frequency transducer that provides adequate depth penetration should be used. The iliac arteries are then examined separately to the level of the groin with the transducer placed at the level of the iliac crest to evaluate the middle to distal common iliac and proximal external iliac arteries (Figure 17-5). Each lower extremity is examined beginning with the common femoral artery and working distally. adults: <3 mm. In: Bernstein EF, ed. Transthoracic echocardiography revealed severe tricuspid regurgitation due to tricuspid annular dilatation with a preserved LVEF of . Normal arterial waveforms in the proximal left pro- . The ability to visualize flow throughout a vessel improves the precision of pulsed Doppler sample volume placement for obtaining spectral waveforms. Data from Jager KA, Ricketts HJ, Strandness DE Jr: Duplex scanning for the evaluation of lower limb arterial disease. Also the Superficial femoral artery at the origin, proximally, mid and distally. Identification of these vessels. FIGURE 17-2 Color flow image of the posterior tibial and peroneal arteries and veins. Ultrasound Assessment of Lower Extremity Arteries, Ultrasound in the Assessment and Management of Arterial Emergencies, Ultrasound Contrast Agents in Vascular Disease, Ultrasound Assessment of the Vertebral Arteries, Introduction to Vascular Ultrasonography Expert Consult - Online. Examination of the abdominal aorta and iliac arteries is facilitated by scanning the patient following an overnight fast to reduce interference by bowel gas. The deep and superficial portions continue on down the leg. Spectral waveforms obtained distal to a severe stenosis or occlusion are generally monophasic and damped with reduced PSV, resulting in a tardus-parvus flow pattern. Examinations of 278 limbs in 185 patients with peripheral arterial disease were performed. The initial application of duplex scanning concentrated on the clinically important problem of extracranial carotid artery disease.

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